{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T03:13:09Z","timestamp":1777086789312,"version":"3.51.4"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2015,1,30]]},"abstract":"\n Background<\/jats:title>\n \n Significant mitral regurgitation (\n MR<\/jats:styled-content>\n ) typically occurs as holosystolic (\n HS<\/jats:styled-content>\n ) or mid\u2010late systolic (\n MLS<\/jats:styled-content>\n ), with differences in volumetric impact on the left ventricle (\n LV<\/jats:styled-content>\n ). We sought to assess outcomes of degenerative\n MR<\/jats:styled-content>\n patients undergoing exercise echocardiography, separated based on\n MR<\/jats:styled-content>\n duration (\n MLS<\/jats:styled-content>\n versus\n HS<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We included 609 consecutive patients with \u2265\n III<\/jats:styled-content>\n +myxomatous\n MR<\/jats:styled-content>\n undergoing exercise echocardiography:\n HS<\/jats:styled-content>\n (n=487) and\n MLS<\/jats:styled-content>\n (n=122).\n MLS MR<\/jats:styled-content>\n was defined as delayed appearance of\n MR<\/jats:styled-content>\n signal during mid\u2010late systole on continuous\u2010wave Doppler while\n HS MR<\/jats:styled-content>\n occurred throughout systole. Composite events of death and congestive heart failure were recorded. Compared to\n MLS MR<\/jats:styled-content>\n ,\n HS MR<\/jats:styled-content>\n patients were older (60\u00b114 versus 53\u00b114\u00a0years), more were males (72% versus 53%), and had greater prevalence of atrial fibrillation (16% versus 7%; all\n P<\/jats:italic>\n <0.01).\n HS MR<\/jats:styled-content>\n patients had higher right ventricular systolic pressure (\n RVSP<\/jats:styled-content>\n ) at rest (33\u00b111 versus 27\u00b19\u00a0mm\u00a0Hg), more flail leaflets (36% versus 6%), and a lower number of metabolic equivalents (\n MET<\/jats:styled-content>\n s) achieved (9.5\u00b13 versus 10.5\u00b13), compared to the\n MLS MR<\/jats:styled-content>\n group (all\n P<\/jats:italic>\n <0.05). There were 54 events during 7.1\u00b13\u00a0years of follow\u2010up. On step\u2010wise multivariable analysis,\n HS<\/jats:styled-content>\n versus\n MLS MR<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n 4.99 [1.21 to 20.14]), higher\n LV<\/jats:styled-content>\n ejection fraction (hazard ratio [\n HR<\/jats:styled-content>\n ], 0.94 [0.89 to 0.98]), atrial fibrillation (\n HR<\/jats:styled-content>\n , 2.59 [1.33 to 5.11]), higher\n RVSP<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n , 1.05 [1.03 to 1.09]), and higher percentage of age\u2010 and gender\u2010predicted\n MET<\/jats:styled-content>\n s (\n HR<\/jats:styled-content>\n , 0.98 [0.97 to 0.99]) were independently associated with adverse outcomes (all\n P<\/jats:italic>\n <0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n In patients with \u2265\n III<\/jats:styled-content>\n +myxomatous\n MR<\/jats:styled-content>\n undergoing exercise echocardiography, holosystolic\n MR<\/jats:styled-content>\n is associated with adverse outcomes, independent of other predictors.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.114.001348","type":"journal-article","created":{"date-parts":[[2015,2,12]],"date-time":"2015-02-12T05:40:03Z","timestamp":1423719603000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of Duration of Mitral Regurgitation on Outcomes in Asymptomatic Patients With Myxomatous Mitral Valve Undergoing Exercise Stress Echocardiography"],"prefix":"10.1161","volume":"4","author":[{"given":"Peyman","family":"Naji","sequence":"first","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadi","family":"Asfahan","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler","family":"Barr","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. Leonardo","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard A.","family":"Grimm","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shikhar","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Marc","family":"Gillinov","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomislav","family":"Mihaljevic","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian P.","family":"Griffin","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milind Y.","family":"Desai","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, 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